Healthcare Provider Details

I. General information

NPI: 1376727214
Provider Name (Legal Business Name): PROLIANCE SURGEONS INC P S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SW 160TH ST STE 200
BURIEN WA
98166-3003
US

IV. Provider business mailing address

275 SW 160TH ST STE 200
BURIEN WA
98166-3003
US

V. Phone/Fax

Practice location:
  • Phone: 206-988-0933
  • Fax:
Mailing address:
  • Phone: 206-988-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number601484763
License Number StateWA

VIII. Authorized Official

Name: CORI M. PLEASANT
Title or Position: DEL CRED & ENROLLMENT MANAGER
Credential:
Phone: 206-838-2585